Trump administration offers advice to providers on how to split use of ventilators as capacity concerns grow

The Trump administration gave advice for health systems on how to split ventilators to be used on two patients at once. (Getty images/sturti)

The Trump administration offered guidance to providers on how to properly split a ventilator to serve two patients at once but cautioned the modification should only be used as an “absolute last resort.”

The U.S. Public Health Service Corps sent out guidance and technical documents to providers Tuesday on how to split ventilators as well as a guide on the anticipated problems a hospital could face employing the strategy.

A lack of ventilators has been a major issue for providers as the number of COVID-19 cases has surged throughout the country, threatening to overwhelm many systems. Some hospitals and experts have floated the idea of having one ventilator take on two patients in order to shore up capacity, but the practice is controversial.

The administration cautioned that splitting ventilators should only be used as an “absolute last resort.”

“These decisions must be made on an individual institution, care-provider and patient level,” the guidance said. “However, we do know that many institutions are evaluating this practice and protocols are being developed and tested, and some places, preliminarily implemented.”

The guidance includes a statement by the Centers for Disease Control and Prevention that the infection control implications for splitting ventilators aren’t “firmly established since it would not meet general established standards for infection control for ventilated patients.”

However, if a facility employs the currently established infection control interventions needed to reduce ventilator-associated infections then any additional risk from splitting is “likely to be small and would likely be appropriate in a crisis standard of care,” the guidance said.

The Food and Drug Administration also added that it doesn’t object to creating a T-connector outlined in instructions to providers to split a ventilator.

But while the administration appears to be fine with splitting ventilators as a last resort to shore up capacity, not all providers are.

Adam Schlifke, M.D., a board-certified anesthesiologist and a clinical assistant professor at Stanford University in California, said sharing ventilators is a bad idea as patients cannot be properly monitored.

“I’ll tell you, it’s a Pandora’s box,” he said, with a preferred solution to re-purpose anesthesia machines from operating rooms or increasing the supply of ventilators.

Schlifke leads a group of anesthesiologists and other professionals called CovidVent that has called for turning operating rooms and surgery centers into critical care units for patients in order to free up hospital beds and ventilators.

"It is dangerous,” Schlifke said, about the idea of splitting ventilation between two patients. With only one way to monitor the split, there’s a risk of causing trauma or hypoventilating patients. “It’s a very hard thing to manage and it’s not something providers are used to doing because it’s never really been done before.”

“At the end of the day, of all the ways we could increase the supply of ventilation, that would be my last choice,” he said.